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of intra-articular lidocaine may be worthwhile in skeletally mature adolescents
given the added benefits of decreased procedure time and potentially reduced
cost.
Clinical Considerations
Clinical Recognition. The patient with a shoulder dislocation usually presents
with substantial pain, holding their injured arm supported by the uninjured arm.
There is often an obvious abnormality with loss of the usual rounded contour of
the shoulder with the dislocation.

FIGURE 111.11 Hill–Sachs deformity with anterior humeral dislocation. A: AP shoulder
demonstrating an anteroinferior dislocation of the humerus with impaction between the inferior
glenoid rim and the opposing humeral head (arrow ). The impaction produces the articular
defect that has been referred to as the hatchet deformity (Hill–Sachs defect). B: Postreduction,
AP shoulder. After repositioning the humeral head within the glenoid fossa, the residual effect
of compression of the articular surface is clearly identified (arrow ). (Reprinted with permission
from Yochum TR, Rowe LJ, eds. Yochum and Rowe’s Essentials of Skeletal Radiology . 3rd ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2004.)

Triage Considerations. The patient should be given adequate pain medication,
and the injured upper extremity should be placed in a sling. This injury warrants
an expedited triage for timely shoulder reduction.